Ecmo therapy: Experts alarmed over pandemic death rates
Created: 03/15/2022, 08:52
Employee of a corona intensive care unit with an Ecmo device.
© Fabian Strauch/dpa
If the lungs fail, this therapy can be the last hope for Covid 19 patients: a device as a temporary replacement.
But is that always in the best interest of the patient?
Berlin - Blood flows out of the patient's body through thick cannulas.
Your lungs don't have to work temporarily, a machine next to the bed takes over the function.
This enriches the blood with oxygen before it is returned.
In the winter of 2015/16, Sabine Weiß (name changed) suffered severe acute lung failure as a result of a flu infection.
In a university clinic, doctors connect the then 50-year-old to a so-called Ecmo device: practically an artificial lung that is supposed to give the vital organ time to recover.
According to Weiss, he was in a coma for a total of around a month, 16 of which were at the Ecmo.
She has very few memories of that time.
"I was sort of between the spheres: once my mother, who had died a year earlier, appeared to me in a dream.
She said she was fine where she is.” As Weiss is told afterwards, her husband visited her every day.
She thinks she sensed his care.
When she was taken out of the coma at the end of January 2016, she was disoriented.
However, she does not find the many tubes on her body and the situation in general to be bad.
"There was always confidence to get well."
Numbers frighten experts
The therapy that saved Weiss' life - extracorporeal membrane oxygenation (ECMO) - has also become better known outside of specialist circles in the Covid 19 pandemic.
Because like many other respiratory pathogens, Sars-CoV-2 can trigger severe acute lung failure.
The pictures of infected people struggling for their lives on Ecmo devices could be seen in photos in newspapers and in TV documentaries.
Thousands are likely to have been affected by spring 2022, but final data is not yet available.
However, the numbers that are already known about the pandemic in Germany alarm experts.
Because a much higher proportion of Ecmo patients died in hospital than was usual before the pandemic.
Depending on the type of Ecmo therapy, 72 or around 66 percent of those suffering from Covid 19 did not survive, according to a group led by specialist Benjamin Friedrichson from the University Hospital Frankfurt in a study from the end of February in the “European Journal of Anaesthesiology”.
To do this, they analyzed all 4279 Ecmo treatments in Covid 19 patients in German hospitals between January 2020 and the end of September 2021. International publications with the results from mostly specialized centers therefore reported significantly better rates, with only 37 or 53 dying there, depending on the study Percent.
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Contrary to what might be expected given the initial lack of experience with Covid-19, the results did not improve over the course of the pandemic.
"The doctors in this country don't make bad medicine and Ecmo is a wonderful therapy that we don't want to do without," says Friedrichson.
"The results are also very good for younger people." In Germany, however, compared to other countries, many people over the age of 60 were treated at Ecmo.
In this older group, more than three quarters (77 percent - "unacceptably high" according to the study) died.
That affects the overall result.
Thomas Bein, former intensive care physician at the University Hospital Regensburg and co-author of a previous study with similar results, says: "The Ecmo was used too uncritically and unregulated during the corona pandemic: as a last resort when nothing else helped." He speaks of one "Quality problem" and considers stronger regulation necessary.
In Germany, a relatively large number of clinics offer Ecmo for acute lung failure: more than 270 according to the latest data from 2020, around 40 more than two years earlier, as Friedrichson said.
According to experts, Corona should have caused further spread.
"Eight clinics in the UK are currently doing Ecmo"
Steffen Weber-Carstens, intensive care doctor at the Charité, gives a comparative figure: “Across Great Britain, eight clinics are currently using Ecmo.
Patients are transferred there.” Few hospitals have many patients per year, in this country it is often the other way around.
"Ecmo belongs in very experienced hands, there is a high potential for complications and side effects.
However, many hospitals, especially smaller ones, do not have the expertise,” says Bein.
Centers with more than 20 or 30 patients per year are considered experienced.
Doctors also have to be careful not to cause unnecessary suffering, says Bein.
Even those who leave the hospital alive after Ecmo therapy are often no longer the same person as before.
Many former patients died in the year after discharge.
You shouldn't give your family false hope.
“I plead for more restraint in old age.
To put it bluntly, you just delay death.”
Sabine Weiß is still grateful that the therapy exists, as she says.
It took her half a year to get physically fit again afterwards.
Today she describes the chapter of her serious illness as closed.
She lives more intensely than before.
The longtime camper raves about the first flight with her husband recently.
When she hears criticism of the overly generous use of Ecmo in the pandemic, she becomes thoughtful.
She says: "We all have a right to life." dpa
